Healthcare Provider Details

I. General information

NPI: 1740749175
Provider Name (Legal Business Name): SUNFLOWER COUNSELING SERVICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2019
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6628 ELMORE WOODS CV
MEMPHIS TN
38134-4745
US

IV. Provider business mailing address

1235 TIMBERBROOK LN APT 5
MEMPHIS TN
38134-8156
US

V. Phone/Fax

Practice location:
  • Phone: 601-575-6021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBIN COUGHLIN
Title or Position: CO-OWNER
Credential:
Phone: 601-575-6021